Analgesic Effects of Different Local Infiltration Anesthesia Techniques Combined with Femoral Nerve Block in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Clinical Trial

Overview

Journal Local Reg Anesth

Publisher Dove Medical Press

Date 2023 Dec 27

PMID 38148969

Authors

Yong-Kang Gui

Rui Xiao

Ya-Ru Luo

Yang Liu

Xin Da

Si-Hui Zhu

De-Wen Shi

Xu-Dong Hu

Guang-Hong Xu

Affiliations

Soon will be listed here.

Abstract

Objective: Pain after total knee arthroplasty (TKA) remains an unresolved problem. Femoral nerve block (FNB) could relieve pain; however, it alone is insufficient. The local infiltration anesthesia technique (LIA) has been suggested as a supplement to FNB. This study aimed to evaluate the analgesic effects of different LIA combined with FNB in TKA patients.

Methods: The femoral nerve was blocked with 0.375% ropivacaine 20mL, and all patients routinely received general anesthesia. The primary indicator was the proportion of patients who did not receive post-operative remedial analgesia. Seventy-eight patients were randomly assigned to PAI (periarticular injection combined with FNB), IAI (intra-articular injection combined with FNB), or control (FNB alone) groups. All patients underwent FNB under general anesthesia. The primary outcome was the proportion of patients who did not receive additional postoperative analgesia within the first 48 h after surgery.

Results: Compared with the PAI and control groups, the IAI group had a higher proportion (69.23%) of patients who did not receive remedial analgesia within 48 hours after surgery ( = 0.009; = 0.009), a lower consumption of diclofenac sodium lidocaine ( = 0.021; < 0.001), and an earlier time of walking with a walker ( < 0.001; < 0.001). The time of first need for remedial analgesia postoperatively in IAI group was longer than the PAI group ( = 0.008) and IAI group has a shorter hospital stay than the control group ( = 0.008). The maximum NRS during the first 48 hours postoperatively and NRS 24 hours after surgery in the IAI group were lower than those in the control and PAI groups. The incidences of POD and PONV were similar among the three groups ( = 0.610; = 0.264).

Conclusion: When combined with FNB, intra-articular injection offers a superior analgesic effect and favorable recovery compared to periarticular injection and separate application of FNB.

References

Lutzner J, Gehring R, Beyer F . Slightly better pain relief but more frequently motor blockade with combined nerve block analgesia compared to continuous intraarticular analgesia after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2020; 28(4):1169-1176. PMC: 7148269. DOI: 10.1007/s00167-019-05843-2. View

Tierney E, Lewis G, Hurtig J, Johnson D . Femoral nerve block with bupivacaine 0.25 per cent for postoperative analgesia after open knee surgery. Can J Anaesth. 1987; 34(5):455-8. DOI: 10.1007/BF03014348. View

Wu C, Naqibuddin M, Rowlingson A, Lietman S, Jermyn R, Fleisher L . The effect of pain on health-related quality of life in the immediate postoperative period. Anesth Analg. 2003; 97(4):1078-1085. DOI: 10.1213/01.ANE.0000081722.09164.D5. View

Albrecht E, Guyen O, Jacot-Guillarmod A, Kirkham K . The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth. 2016; 116(5):597-609. DOI: 10.1093/bja/aew099. View

Chan E, Fransen M, Parker D, Assam P, Chua N . Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev. 2014; (5):CD009941. PMC: 7173746. DOI: 10.1002/14651858.CD009941.pub2. View

Xu J, Chen X, Ma C, Wang X . Peripheral nerve blocks for postoperative pain after major knee surgery. Cochrane Database Syst Rev. 2014; (12):CD010937. DOI: 10.1002/14651858.CD010937.pub2. View

Rice D, Kluger M, McNair P, Lewis G, Somogyi A, Borotkanics R . Persistent postoperative pain after total knee arthroplasty: a prospective cohort study of potential risk factors. Br J Anaesth. 2018; 121(4):804-812. DOI: 10.1016/j.bja.2018.05.070. View

Cheng K, Feng B, Peng H, Bian Y, Zhang L, Han C . The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial. BMC Anesthesiol. 2020; 20(1):2. PMC: 6942284. DOI: 10.1186/s12871-019-0922-4. View

Ranawat A, Ranawat C . Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplasty. 2007; 22(7 Suppl 3):12-5. DOI: 10.1016/j.arth.2007.05.040. View

10.

Grosu I, Lavandhomme P, Thienpont E . Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc. 2013; 22(8):1744-58. DOI: 10.1007/s00167-013-2750-2. View

11.

Moghtadaei M, Farahini H, Faiz S, Mokarami F, Safari S . Pain Management for Total Knee Arthroplasty: Single-Injection Femoral Nerve Block versus Local Infiltration Analgesia. Iran Red Crescent Med J. 2014; 16(1):e13247. PMC: 3964426. DOI: 10.5812/ircmj.13247. View

12.

Kinghorn K, Ellinas H, Barboi A, Dolinski S . Case scenario: nerve injury after knee arthroplasty and sciatic nerve block. Anesthesiology. 2012; 116(4):918-23. DOI: 10.1097/ALN.0b013e31824bdfab. View

13.

Fowler S, Symons J, Sabato S, Myles P . Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2008; 100(2):154-64. DOI: 10.1093/bja/aem373. View

14.

Grape S, Kirkham K, Baeriswyl M, Albrecht E . The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty: a systematic review and meta-analysis. Anaesthesia. 2016; 71(10):1198-209. DOI: 10.1111/anae.13568. View

15.

Tanikawa H, Harato K, Ogawa R, Sato T, Kobayashi S, Nomoto S . Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty. J Orthop Surg Res. 2017; 12(1):109. PMC: 5505044. DOI: 10.1186/s13018-017-0616-x. View

16.

Parvataneni H, Shah V, Howard H, Cole N, Ranawat A, Ranawat C . Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty. 2007; 22(6 Suppl 2):33-8. DOI: 10.1016/j.arth.2007.03.034. View

17.

Andersen L, Kehlet H . Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth. 2014; 113(3):360-74. DOI: 10.1093/bja/aeu155. View

18.

Jain R, Porat M, Klingenstein G, Reid J, Post R, Schoifet S . The AAHKS Clinical Research Award: Liposomal Bupivacaine and Periarticular Injection Are Not Superior to Single-Shot Intra-articular Injection for Pain Control in Total Knee Arthroplasty. J Arthroplasty. 2016; 31(9 Suppl):22-5. DOI: 10.1016/j.arth.2016.03.036. View

19.

Macrinici G, Murphy C, Christman L, Drescher M, Hughes B, Macrinici V . Prospective, Double-Blind, Randomized Study to Evaluate Single-Injection Adductor Canal Nerve Block Versus Femoral Nerve Block: Postoperative Functional Outcomes After Total Knee Arthroplasty. Reg Anesth Pain Med. 2016; 42(1):10-16. DOI: 10.1097/AAP.0000000000000507. View

20.

Fan L, Yu X, Zan P, Liu J, Ji T, Li G . Comparison of Local Infiltration Analgesia With Femoral Nerve Block for Total Knee Arthroplasty: A Prospective, Randomized Clinical Trial. J Arthroplasty. 2016; 31(6):1361-1365. DOI: 10.1016/j.arth.2015.12.028. View